Impact of neck CT on the management of suspected pediatric deep neck space infection.

OBJECTIVE To identify clinical and radiographic factors that predict successful medical management in children with suspected deep neck space infection. METHODS Retrospective chart review of 313 immunocompetent children admitted to a tertiary care children's hospital after undergoing a CT scan for a suspected neck abscess. RESULTS A rim-enhancing hypodensity, suggestive of an abscess, was identified in 131/313 patients (42%). Medical management with IV antibiotics was utilized for more than 24 h in 57/131 (43%) of children with radiographic findings suggestive of a coalescent or evolving abscess. Medical management was successful in 36/57 (63%) of patients with a rim-enhancing collection. Children who underwent incision and drainage within 24 h had a larger fluid collection than those who underwent initial medical management (mean diameter 30 mm vs 20.5 mm; p < 0.0001), however, there was no difference between the size of abscesses that failed medical management compared to those successfully managed with IV antibiotics (22.9 mm vs 19.1 mm; p = 0.07). Clinical factors and white blood cell count were not predictive of response to antibiosis. CONCLUSION The majority of children with suspected DNSI were successfully managed with IV antibiotics alone, however, clinical and radiographic factors are not reliable predictors of successful medical management. In children who are hemodynamically stable without airway symptoms, one should consider a trial of IV antibiotics prior to requesting a CT scan.